Concurrent radiation therapy and chemotherapy is the standard of care for node positive cervical cancer. While there are several acceptable means to boost the disease in the low pelvis (i.e. brachytherapy, IMRT, or external beam), there is limited research into boosting gross disease in the pelvis or para-aortic region. This protocol is designed to determine the maximum tolerated dose of treating tumor bearing regions within the abdomen and pelvis, using an integrated boost technique and concurrent chemotherapy.

Secondary Outcome Measures:

Local-regional control with integrated boost radiation therapy (TTLR) [ Time Frame: 3 years following treatment ] [ Designated as safety issue: No ]

Time to distant recurrence (TTDR) [ Time Frame: 3 tears after treatment ] [ Designated as safety issue: No ]

Acute DLT will be defined based on the side effects inherent from radiation therapy for gynecologic cancers, including effects on bowel, bladder, and skin.Since integrated radiation dose escalation is unlikely to substantially affect the hematopoietic system, only non-hematologic, grade 3-4, acute toxicity will be considered the primary dose-limiting toxicity (acute DLT). Dose limiting toxicity will include any of the following during treatment or within 6 weeks of completion:

Acute Grade 3-4 enteritis or proctitis

Acute Grade 3-4 bladder toxicity

Acute Grade 4 dermatologic toxicity

The number of late dose limiting toxicities (DLT) [ Time Frame: 3 years following treatment ] [ Designated as safety issue: Yes ]

Late DLTs will be defined at grade 3-4 GI or GU toxicity with onset after 6 weeks of treatment.

Many studies have utilized a sequential boost to deliver a total dose of 55 - 60 Gy to the pelvic sidewall (covering the lower pelvic lymph nodes), including 8-10 Gy that is usually delivered with brachytherapy (1-3). This study treatment plan will escalate the dose to pelvic and para-aortic nodal disease from 60 Gy in 2.4 Gy per fraction to 70Gy in 2.8 Gy per fraction in 3 dose cohorts, using an integrated boost technique utilizing the same number of fractions for all cohorts (25 fractions) while the elective volumes are held constant at 45Gy

Experimental: Boost Radiation: Dose level 2

2.6 Gy X 25 fractions = 65 Gy

Radiation: Boost radiation

Many studies have utilized a sequential boost to deliver a total dose of 55 - 60 Gy to the pelvic sidewall (covering the lower pelvic lymph nodes), including 8-10 Gy that is usually delivered with brachytherapy (1-3). This study treatment plan will escalate the dose to pelvic and para-aortic nodal disease from 60 Gy in 2.4 Gy per fraction to 70Gy in 2.8 Gy per fraction in 3 dose cohorts, using an integrated boost technique utilizing the same number of fractions for all cohorts (25 fractions) while the elective volumes are held constant at 45Gy

Experimental: Boost Radiation: Dose level 3

2.8 Gy x 25 fractions = 70 Gy

Radiation: Boost radiation

Many studies have utilized a sequential boost to deliver a total dose of 55 - 60 Gy to the pelvic sidewall (covering the lower pelvic lymph nodes), including 8-10 Gy that is usually delivered with brachytherapy (1-3). This study treatment plan will escalate the dose to pelvic and para-aortic nodal disease from 60 Gy in 2.4 Gy per fraction to 70Gy in 2.8 Gy per fraction in 3 dose cohorts, using an integrated boost technique utilizing the same number of fractions for all cohorts (25 fractions) while the elective volumes are held constant at 45Gy

Experimental: Experimental: Boost Radiation Dose Level 0

If the 2 dose limiting toxicities are documented at dose level 1, therapy will be de-escalated to Dose level 0 defined below.

Dose level 0: 2.2 Gy X 25 fractions = 55 Gy

Radiation: Boost radiation

Many studies have utilized a sequential boost to deliver a total dose of 55 - 60 Gy to the pelvic sidewall (covering the lower pelvic lymph nodes), including 8-10 Gy that is usually delivered with brachytherapy (1-3). This study treatment plan will escalate the dose to pelvic and para-aortic nodal disease from 60 Gy in 2.4 Gy per fraction to 70Gy in 2.8 Gy per fraction in 3 dose cohorts, using an integrated boost technique utilizing the same number of fractions for all cohorts (25 fractions) while the elective volumes are held constant at 45Gy

Eligibility

Ages Eligible for Study:

18 Years and older

Genders Eligible for Study:

Female

Accepts Healthy Volunteers:

No

Criteria

Inclusion Criteria:

Biopsy confirmed malignancy of the gynecologic tract

Involved pelvic or para-aortic lymph nodes

Treatment plan to include delivery of concurrent chemoradiotherapy.

Good performance status

Negative pregnancy test in women of child-bearing potential

Signed study-specific informed consent

Lab results within study specific limits

Exclusion Criteria:

Prior radiation to the abdomen or pelvis

A history of Scleroderma or Inflammatory bowel disease

Contraindication to chemotherapy or radiation

Contacts and Locations

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To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.
For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01627288